Associate Medical Director - Health Plan
Texas Children's Hospital
Houston, TX
Position: Associate Medical Director - Health Plan
Full/Part Time: Full time
Location: Houston, TX, US
Department: Medical Affairs
Shift: 8a - 5p
Job ID: 414623
We’re searching for an Associate Medical Director, someone who’s ready to be part of the best ranked children’s hospital in Texas, and among the best in the nation. In this position, you will be responsible for establishing health plans and medical policies. The Associate Medical Director provides guidance to areas within departments of the Texas Children's Health Plan (TCHP); oversees assigned functions of the health plan; provides support, education, and consultation to Texas Children's System staff and physicians regarding resource utilization, managed care, and continuity of care issues.
Responsibilities:
- Working with the CMOs and Medical Directors, oversee and provide recommendations to continuously improve the implementation of medical management programs as outlined in the policy and procedures, including discharge planning, case and referral management, and the use of clinical protocols and medical review criteria.
- Provide input into the development of medical care guidelines for utilization of behavioral health services and complete medical necessity reviews and appeals of requests for medical care based upon evidence-based guidelines approved by the CAAC.
- Develop guidelines to ensure office sites and medical records meet standards for proper behavioral health care and supervise the use of physician profiles.
- Monitor outcomes of members using data obtained through encounter and claims information, and electronic medical records, identifying strategies to affect outcomes.
- Ensure regulatory compliance and compliance with accreditation agencies such as NCQA and TDI, preparing for inspections and reviews.
- Participate in Committees as directed by the CMOs affecting patient care and medical policy, teaching programs, and consults on managed care as necessary.
- Participate in the Quality Management Program of the Health Plan, collaborating with CMOs on establishing QI standards and assuring their implementation and use.
- Serve as a crucial member of the Health Plan operating team, providing timely and accurate oral and written progress reports at staff meetings.
Requirements:
- Required Doctor of Medicine (M.D.) or Doctorate Doctor of Osteopathic Medicine (D.O.)
- Required Licenses/Certifications: MDL - Medical Doctor License by the Texas Medical Board and BCPP - BCPhysician in Psychiatry by the American Board of Psychiatry & Neurology or BCP - Cert-Board Cert Pediatrician by the American Board of Pediatrics or BCFM - Cert-BoardCert Family Medicine by the American Board of Family Medicine or BCOBGYN - Cert - Board Certified OB-GYN by the American Board of Medical Obstetrics and Gynecology
- Required 5 years Healthcare management, managed care experience, and/or behavioral health experience
- Residency in Psychiatry and Child Psychiatry training, when primary role of the Associate Medical Director is Behavioral Health
- Strong preference for Family Practice and Pediatric physician applicants
About Texas Children’s
Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children, and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals.
Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status, or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
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